Employee Shirt Order Form

Employee Shirt Order Form

Employee polo and denim shirts with the ACH Child and Family Services embroidered logo are available for purchase. To order shirts, please complete the information below and return this form to Lindsay Ray, Communications Specialist in Mallick 201.

Payment for your order will be through a payroll deduction. If you have any questions, please contact Lindsay Ray at ext. 1629. Thank you.

Employee Information

Employee Name
Location/Building
Work Phone /Extension

Shirt order Information

Product # / Men’s/Women’s / Size / Color / Price
Shipping and Handling (add $1.00 per shirt)
Order Total

Payroll Deduction Information

c $______Order total cost to be payroll deducted in paycheck.
Signature Required
Date